The present invention relates to a dental appliance to be worn on the mandible or maxilla to correct tempromandibular joint syndrome and particularly relates to an appliance having contact points forming bilateral fulcrums for pivoting the mandible relative to the maxilla upon clenching the teeth to relieve the syndrome.
Many individuals are affected by tempromandibular joint syndrome (hereafter called TMJS or the syndrome). This syndrome is often manifested by headaches, aches along one side of an individual""s face, a ringing in the ear, sinusitis, soreness, limited range of motion and the like. The syndrome is quite debilitating for the afflicted individuals and is often misdiagnosed by medical professionals. For example, the syndrome has been misdiagnosed as an ear infection and the treatment following that diagnosis has little or no effect in relieving the effects of the syndrome. Dentists and others will sometimes misdiagnose the syndrome as a misalignment of the teeth. The efforts to bring the teeth into alignment, for example, by grinding selected teeth or applying splints, likewise do not relieve the effects of TMJS.
It is believed that the cause of TMJS is stress-induced clenching of the teeth. Individuals, when stressed, tend to clench their teeth, either consciously or unconsciously, and thereby apply constant or periodic tension to the muscles which cause the above-mentioned symptoms. Particularly, the tension caused by the musculature compresses the tempromandibular joint (hereafter the TMJ or the joint). When pressure is applied to the condyle and hence against the fossa during clenching, the cartilage or meniscus between those components is compressed. The bursa containing the synovial fluid also swells which brings about symptoms such as clogging of the ear and sinusitis. As noted previously, these symptoms are oftentimes misdiagnosed as an ear infection and treated accordingly, without relieving the effects of TMJS.
Current treatment modalities for TMJS when properly diagnosed includes application of moist heat, physical therapy, electroshock therapy, steroid injections, crowns for the teeth, splints and even joint replacement. Those treatments, however, often do not relieve the effects of TMJS and, accordingly, there is a need for an appropriate treatment of TMJS.
In accordance with a preferred embodiment of the present invention, there is provided a dental appliance which relieves the adverse effects of TMJS by relieving the pressure on the tempromandibular joint. Particularly, the appliance provides bilateral fulcrums between the teeth of the mandible and maxilla to extend or distract the tempromandibular joint. As a result, the pressure on the joint complex is released. Thus, instead of compressing the fossa/meniscus/condyle when the teeth are clenched, the opposite effect is achieved, i.e., a release of the pressure on the joint. This also releases the musculature involved in clenching. With respect to the lafter, the masseter, temporalis, sternocleidomastoid and trapezius muscles are typically flexed when the teeth are clenched. However, in accordance with the present invention and with use of the appliance hereof, those muscle groups are not only rested but are extended rather 405772 than flexed. The appliance thus affords relief to the meniscus, enabling the meniscus to heal. It also reduces the pressure on the bursa, thereby relieving the effects applied to the auditory canal and the sinuses, reducing muscle strain, eliminating spasms and headaches, and affording an appliance which is reusable at any time the symptoms of stress-induced TMJS occur.
Particularly, the appliance is preferably applied to the mandible but may be applied to the maxilla, with similar beneficial results. The appliance has bilateral contacts which, when the appliance is applied to the mandible, project toward and contact the teeth of the maxilla. Those contacts serve as fulcrums which, when the teeth are clenched, tend to relieve the pressure on the joint. More particularly, when properly formed and applied, the appliance causes contact with the teeth of the maxilla only at the contact points of the appliance on the mandible. This normally leaves gaps between the appliance and the front and back teeth of the maxilla. When the teeth are clenched, the gap between the front teeth closes, relieving the pressure on the tempromandibular joint and extending, rather than flexing, the associated musculature. The contact points are thus located such that the pivot points for the mandible relative to the maxilla shift from the joint to substantially a midpoint along the mandible, i.e., generally bisecting the premolars, as noted more particularly below. It will be appreciated that when the teeth are clenched, the front teeth close toward engagement, causing the pressure between the condyle and fossa to be relieved without causing a swelling of the cartilage or bursa sac. The contact points, i.e., the fulcrums, also alleviate the need to activate the muscle groups normally activated in response to clenching of the teeth. The appliance is preferably worn periodically, for example, at night, during sleep, and should be removed during the day.
Moreover, the appliance may be readily formed and fit for each individual afflicted with TMJS using conventional dental practice techniques. For example, discrete impressions of the teeth of the mandible and maxilla are made and positives are made from those impressions. The location of the bilateral fulcrums is significant as the fulcrums must be located to relieve the pressure on the joint during clenching. If the fulcrum is back too far, the back teeth will contact one another. If too far forward, there is insufficient clearance for displacement of the front teeth to effect a decompression of the joint. In accordance with the present invention, it has been found that the fulcrums should be located substantially adjacent the premolars, preferably bisecting both premolars bilaterally, without any other contact points between the appliance and teeth anteriorly or posteriorly of the two fulcrums. Thus, once the positives are formed, one of the positives, for example, the maxilla, can be notched at the fulcrums, i.e., at a location approximately over the second premolar and a portion of the first premolar. The mandible is then placed in a vacuum former and thermoplastic material is drawn about the mandible to form the appliance. While the plastic material is soft, the positive of the maxilla is brought to bear against the material whereby the material flows into the notches forming the fulcrums. Preferably, these contact points are flat along their projecting surfaces, both front-to-back and side-to-side. With the fulcrums thus formed, the appliance is removed from the vacuum former and applied to the patient. The appliance is then finely adjusted, e.g., by removing thermoplastic material at one or both of the fulcrums, to ensure that the fulcrums engage simultaneously in the patient""s mouth without any other teeth abutting one another or abutting the appliance.
In a further preferred embodiment, the appliance may be fabricated from a positive of either the teeth of the mandible or maxilla. For example, where a positive model of the teeth of the mandible is formed by taking an impression, a pair of small plastic inserts or pieces may be located on top of the teeth at the predetermined location of the fulcrums. Thus, the plastic inserts can be adhered over the top of the teeth of the positive at the locations of the second premolar and a portion of the first premolar on opposite sides of the positive. With the inserts adhered to the positive of the mandibular model, the unit may be placed in a vacuum former and dental thermoplastic material is drawn about the mandible to form the appliance. It will be appreciated that the finished appliance when removed from the vacuum former will have a pair of projections or fulcrums at the desired locations. The thickness of each insert may be about 0.150 inches, while the thickness of the appliance material may likewise be about 0.150 inches, thus forming a fulcrum projecting from the appliance surface approximately 0.150 inches.
It will be appreciated that the appliance preferably extends in a full U-shaped arch. However, it can also be formed of two discrete bilateral sections rather than into a full arch. Further, rotation of the mandible about the fulcrum must be free, i.e., the front teeth must be spaced from one another prior to rotation. This ensures, that when the patient clenches, the contacts points cause the mandible to pivot forwardly and upwardly about the fulcrums, thereby relieving the pressure on the joint and alleviating the effects of TMJS.
In a preferred embodiment according to the present invention, there is provided an appliance for correcting tempromandibular joint syndrome comprising an appliance body for disposition along teeth on one of the mandible and the maxilla and having a contact projecting toward and for contacting the teeth of another of the mandible and the maxilla, whereby the contact serves as a fulcrum to relieve pressure on the tempromandibular joint in response to clenching of the teeth.
In a further preferred embodiment according to the present invention, there is provided an appliance for correcting tempromandibular joint syndrome comprising an appliance body for disposition along teeth on one of the mandible and the maxilla and having bilateral contacts projecting toward and for contacting the teeth of another of the mandible and the maxilla, whereby the contacts serve as fulcrums to relieve pressure on the tempromandibular joint in response to clenching of the teeth.
In a still further preferred embodiment according to the present invention, there is provided a method of treating tempromandibular joint syndrome comprising the steps of relieving the pressure on the tempromandibular joint by causing the mandible to pivot in a direction tending to displace the condyle away from the fossa.
In a still further preferred embodiment according to the present invention, there is provided a method of forming an appliance for correcting tempromandibular joint syndrome comprising the steps of forming an impression of the teeth of an individual""s mandible and maxilla, forming a positive of the teeth of the mandible and maxilla from the impressions, providing bilateral notches in the teeth of one of the positives of the teeth of the mandible and maxilla, forming a soft plastic material about the teeth of another of the positives of the mandible and maxilla to form an appliance body and while the thermoplastic material is soft and formable, relatively closing the positives of the teeth of the mandible and maxilla toward one another such that the plastic material enters the notches, thereby forming an appliance having raised bilateral contact points for projecting toward opposed registering teeth in use.
In a still further preferred embodiment according to the present invention, there is provided a method of forming an appliance for correcting tempromandibular joint syndrome comprising the steps of forming an impression of the teeth of an individual""s mandible or maxilla, forming a positive of the teeth of the mandible or maxilla from the impression, providing inserts at predetermined bilateral locations along the positive of the teeth of the mandible or maxilla and forming a soft plastic material about the inserts and the positive of the teeth of the mandible or maxilla to form an appliance body having raised bilateral contact points for projecting toward opposed registering teeth when the appliance is worn by an individual.